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#AUA17: Highlights from Boston part 1

It was a cold and wet Boston that welcomed the thousands of delegates from around the world for the start of #AUA17. Being home to such pre-eminent centres of learning and academia as Harvard, MIT and Fenway Park, we looked forward to a productive and enjoyable meeting. Set on the South Boston Waterfront, the Boston Convention and Exhibition Centre offered an elegant home to us for the next 5 days and provided all the necessary tools for scientific discussion: numerous coffee shops and speedy wi-fi.

Friday morning started off with a fascinating plenary session hosted by Prof Prokar Dasgupta (@prokarurol) on surgical techniques in radical prostatectomy. Three great “as live” demonstrations of open perineal, laparoscopic and robotic single site prostatectomy thrilled the packed room and once again demonstrated that it really isn’t the technique but the surgeon that really counts.

Following on in the plenary hall, the Tumour Boards offered informative panel discussions on all the major tumours. Of note the multidisciplinary discussion on prostate cancer highlighted some important key messages. Use of risk calculators was emphasised as well as the importance of reducing our reliance on PSA and the number of biopsies. Dr Stacey Loeb (@staceyloeb) gave some helpful reasons for the greater incorporation of the prostate cancer biomarkers into the clinical decision making process. But Dr Kibel made the excellent point that especially with all these new tests, the key is that we and, more importantly, the patients believe the results.

Similarly, the bladder cancer panel offered a number of points for discussion. Interestingly Dr Ashish Kamat(@UroDocAsh) highlighted the discrepancies between the EAU and AUA in risk stratification of high grade tumours which prompted extensive discussion in the twitter-sphere.

The potential for the new urinary markers to aid prostate cancer risk stratification featured prominently throughout the conference. The clear message was for their greater integration with other diagnostic tests such as MRI.

But worrying evidence that urologists in the States are already having to fight with insurance companies for an mpMRI, how easy this will be remains to be seen.

 

The morning in the plenary hall was nicely rounded off by the presentation of the latest AUA guidelines for managing RCC. In particular, the emphasis on biopsy and active surveillance of the small renal mass was strongly promoted.

 

Friday ended with a great evening session on robotic surgery organised by Mount Sinai Hospital. A panel of experts discussed and critiqued a trio of robotic procedures performed by Dr Tewari (Prostatectomy), Dr Badani (Kidney) and Dr Wiklund (Bladder). Despite the lengthy queues for the free snacks, Mount Sinai Hospital put on a great evening with some truly incredible 4K 3d video courtesy of Sony.

 

And for those urologists that have managed to resist the alluring charms of the Da Vinci Robot, an AUA trip to Fenway park offered the chance to enjoy something some top-level baseball as well as the classic Boston snack of the Fenway Frank (Hotdog). Even if the precise rules of baseball remained somewhat of an enigma, the great atmosphere inside the ground, not to mention the Jumbotron proposal, meant a fantastic evening was had by all.

 

Saturday morning kicked off with another strong programme. Dr Robert Sweet’s Journal of Urology lecture gave us some pause for thought. Entitled “Staying Relevant in the Modern Age”, Dr Sweet set out a very persuasive case why it is up to us as urologists to take charge of training and accreditation. Especially since device manufacturers wash their hands of any responsibility, before adopting any new technology it is vital that we recognise the learning curve and ensure the correct systems are in place.

 

The journal of urology top papers of 2016 provided a handy summary of the new hot topics and points of interests. In particular recognition of the worryingly aggressive but also MRI-invisible cribiform subtype of prostate cancer caught the audience’s’ attention.

 

The AUA further supported the importance of education and training with an extensive presentation programme. The benefits of crowdsourcing where endorsed by a number of presentations led by a plenary presentation by Dr Khurshid Ghani (@peepeeDoctor). Crowdsourced reviews of videos of robotic prostatectomies performed by expert surgeons were again shown to be effective, this time correlating closely with patient outcomes.

 

Similarly, Dr Tom Lendvay (@LendvayT) presented even more surprising data that when compared to expert reviewers, the Mechanical Turks (as the crowdsource workers on Amazon are known) gave more reliable and consistent evaluations! Given the growing calls for ongoing technical assessment of surgeons together with the time and financial expense of recruiting expert surgeon appraisers, the somewhat unpalatable option of crowdsourced assessment of surgeons continues to grow.

 

The highly popular crossfire debates returned with Dr Gerhard Fuchs (@GerhardFuchs9) leading a lively debate on dusting vs basketing. Dr Olivier Traxer and Dr Khurshid Ghani (@peepeedoctor) made a strong case for dusting in front of a packed crowed. But the “basketeers” championed by Dr Sara Best (@BestSaraMD) and Dr Jodi Antonelli defended well. Backed up by a strong SoMe debate, the final opinion was that as with everything the key is selecting the right technique for the right patient although the definition of dust was still hotly contested.

 

SoMe was of course a critical component of the conference, with some lively debates really helping to create the feeling of a very inclusive and connected conference despite the thousands of delegates. SoMe also featured strongly in the presentations with interesting studies showing both a relationship between social media presence on online ratings and surgical volume.

 

The highlight of the Saturday evening was the highly popular annual BJUI Social Media Awards. The city bar of the Westin Waterfront quickly filled and Prof Prokar Dasgupta kicked off the evening with a boisterous but nevertheless very warm welcome. A/Prof Declan Murphy, compère for the night, presented the many awards for the organisations and individuals that had done most to promote SoMe in urology. Best urology journal for social media was awarded to the Journal of Urology – recognising the significant steps they have made recently in this field. Other winners included Dr Stacey Loeb for best social media paper, the EAU for the best app and Christopher Wallis for the most read blog.

 

By Jonathan Makanjuola (@jonmakurology) and Nicholas Raison (@NicholasRaison)

 

 

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